To make a policy point here, Washington spends a lot more time arguing about how to finance health insurance than how to deliver health. But if you're securely in the middle class with employer-sponsored health insurance, these debates probably don't affect you much. What does affect you is the possibility of dying of a hospital-acquired superbug when you go in for a routine surgery at age 62.These kinds of quality issues get a lot less attention in the Beltway, but given that about 85 percent of Americans have health insurance of some sort or another, they probably affect more people. And, in theory at least, preventing superbugs shouldn't be the kind of thing that Democrats and Republicans disagree over.That depends. Is Obama for or against superbugs?

Nice article. Now tell me how many of those 23,000 were because of Multi-drug resistant organisms which failed response to treatment, or did you just cherry-pick the people who died from severe sepsis who happened to have an infection caused by a drug-resistant agent?

I ask because I'm highly doubtful "taking antibiotics" killed 23,000 people. The bacteria killed them. Which may or may not have been induced to have resistance by the improper use of antibiotics.

Ironically, it's been this kind of thing that has seen a drastic drop in the use of antibiotics for empiric therapy in the United States, to the point where unless someone presents with an overwhelming possibility of infectious bacterial agent for their illness, or they meet SIRS criteria, they're NOT going to get antibiotics.

timujin:Wow, more than firearm-related homicides and deaths from drunk driving combined.

These kinds of quality issues get a lot less attention in the Beltway, but given that about 85 percent of Americans have health insurance of some sort or another, they probably affect more people. And, in theory at least, preventing superbugs shouldn't be the kind of thing that Democrats and Republicans disagree over./notsureifserious.jpg

Antibiotics won't kill you, it's the antibiotic resistant bacteria that will kill you.If you ever wanted to see a real life example of evolution in action, our use of antibiotics is resulting in the natural selection of antibiotic resistant bacteria.

I remember the only time I was prescribed antibiotics. The doctor told me I should feel better in a couple of days but that it was absolutely essential that I finish the prescription. He told me that, at the tail end of treatment, even if I felt perfectly fine and there were only two or three pills left, I should take them according to his instructions. Otherwise, he said, the infection could come back in a resistant form and I could get pericarditis and die.

Yes. The doctor actually told me that if I didn't follow his prescription exactly, I was risking death. Naturally, I followed his directions. And, luckily I haven't had the need for antibiotics since. And, I'm thankful for that because the pills made my pee smell weird.

Mister Buttons:These kinds of quality issues get a lot less attention in the Beltway, but given that about 85 percent of Americans have health insurance of some sort or another, they probably affect more people. And, in theory at least, preventing superbugs shouldn't be the kind of thing that Democrats and Republicans disagree over./notsureifserious.jpg

This, and the fact that those with insurance don't get affected more - the bacteria evolve and everyone loses.

I'm on the 'this is not news' crew. What's nearly as bad as infections being resistant, is the havoc antibiotics create for the body's 'good' bacteria. Had a lung infection earlier this year. 3 antibiotics, steroids, breathing treatments, and several weeks later, I was dealing with the side effects of 3 antibiotics and steroids for several more weeks. The cure was almost as tough as the illness.

Abacus9:Is there anyone out there that didn't already know this? It's not even close to being a new thing.

brantgoose: Well, killing is kinda of what antibiotics do. They just aren't very good at it.

Yes they are, bacteria just evolve quickly because they multiply quickly.

I know several people who argue with me constantly that taking anti-biotics when you're sick increases your resistance, because DOCTORS told them to. I don't know what kind of doctors they have, to be honest, or where they bought their medical license. I'm also assuming they get pressured by drug companies to sell as many drugs as possible.

hardinparamedic:Nice article. Now tell me how many of those 23,000 were because of Multi-drug resistant organisms which failed response to treatment, or did you just cherry-pick the people who died from severe sepsis who happened to have an infection caused by a drug-resistant agent?

I ask because I'm highly doubtful "taking antibiotics" killed 23,000 people. The bacteria killed them. Which may or may not have been induced to have resistance by the improper use of antibiotics.

Ironically, it's been this kind of thing that has seen a drastic drop in the use of antibiotics for empiric therapy in the United States, to the point where unless someone presents with an overwhelming possibility of infectious bacterial agent for their illness, or they meet SIRS criteria, they're NOT going to get antibiotics.

timujin: Wow, more than firearm-related homicides and deaths from drunk driving combined.

Actually, Trauma from Accidents is 5th leading cause of all age mortality in the United States, while Sepsis and Septicemia is the 11th cause.

Alright, but what does that have to do with what I wrote? Or were you just adding another data point? Your first question, though, is interesting and I'd love to know the answer.

timujin:Alright, but what does that have to do with what I wrote? Or were you just adding another data point? Your first question, though, is interesting and I'd love to know the answer.

Sorry, the Boobies was not related to you. That's why I quoted you and then replied directly to you.

Sepsis is a major problem - it's our 11th cause of death nationally, but it's less a problem of failure of antibiotic treatment and more of a problem with failure to recognize and treat in the home and clinical settings. Not trying to minimize the problem of improper antibiotic use in the least, but these articles tend to be a fear-mongering fest.

Because of my disability, I'm pretty high risk for UTI's (urinary tract infections). From about the age of 10 until about 15 years ago (roughly 2 decades), I took a maintenance dose of Bactrim (an anti-biotic that's commonly prescribed for bladder/kidney infections). It did limit the number of infections I would get (maybe 1 or 2 a year), but they'd be so serious that I would typically have to spend 2-3 weeks in the hospital each time and on a couple of occasions came very close to total renal failure.

Since I stopped taking the Bactrim, the instances of infection have risen to about 3-5/year but the severity of those infections has been greatly reduced - typically maybe once in 5 years I get something that sends me to the hospital and even then it's only for a few days. Usually a 7-10 days of levaquin tablets is enough to take care of it.

After I moved to Japan I found I was prescribed antibiotics for just about every ailment I came down with. It was pretty obvious that doctors were just prescribing antibiotics to satisfy demands by the patient, so after I received such a prescription when I was just wracked with the flu virus, I stopped going to the doctor for every ailment. It was so easy to go to any doctor I wanted and only have to pay about $20 out of pocket for the whole ordeal. Switching doctors was also a piece of cake, as there was no requirement for a referral or any sort of "preferred provider" bullshiat.

The problem was that they all uniformly doled out antibiotics like Halloween treats.

So I took up drinking instead. Alcohol is an antiseptic and runs through the bloodstream. By keeping a constant stream of alcohol in my blood for most of the day, I am killing the germs and viruses that used to attack successfully. I haven't had a cold in 4 years.

I still take allergy medicine in the spring and early summer to ward off hay fever, and I'll take a Tylenol every now and then to help with the occasional headache, but I don't see the doctors because it's mostly a waste of my time and apparently a danger to my health to take their medicines.

Ivo Shandor:Misuse of antibiotics by humans is a problem. A bigger problem is farmers feeding those antibiotics to livestock as a growth supplement.

You know, for all the crap we get where i live, i can happily say that THIS is not a problem here. 90% of the meat we get from farms is hormone free, antibiotic free and free-range (mostly cause the hormones and anti-Bs are too expensive here to give to the animals, at least in a constant manner). The animals do get anti-B shots when they're sick, though.

1. Agricultural Antibiotics are not necessarily the same chemicals as current human-use antibiotics (about 50% to 60% are shared-use with humans, but some of those are therapeutically obsolete as well), and diseases that make the jump are sort of limited to Campylobacter species andSalmonella. The remainder of the issue as relates to agriculture is limited to cross-exposure of farm dwellers.

So... yes, it's a problem, but no, the impact is not in any way greater than or even as bad as direct human use of therapeutic antibiotics. If you conclusion is meant to be "there will be a problem anyway because of agriculture, I can do what I want" then you are incorrect, if you misuse antibiotics you're contributing much, much more to the problem than cows or chickens.

2. The biggest problem isn't overdiagnosis, either, it's partial courses of treatment. If you're given a course of antibiotics by your doctor, you have to take the full doses, on schedule, even after you feel better. Someone that takes a one-week course of antibiotics may potentially release some resistant bacteria, but most likely their immune system will murder any resistants produced once the nonresistant population is wiped out to well below illness-level.

However, if you take three days in a week-long treatment course, feel better, and figure that you can just not take the rest, you a guaranteed to produce resistant species, and extremely likely to spread them to others. This is how resistant strains are produced in laboratory studies (including one used in the review linked above). It takes about four days for someone on a partial dose of an antibiotic to start producing resistants, if you don't shove the population all the way down to where your immune system nixes the remainder (including the resistants), which requires continuing to kill them off even after you're below the bacterial population that makes you feel bad, you are intentionally creating transmissible resistant strains of your disease.

So if you read articles like this and think you can help by taking less of your prescribed medicine, then you're doing the opposite. And if I sound frustrated about this, it's because behavioral studies indicate that my little hypothetical "get prescribed a week of pills, feel better, stop taking them halfway" was what more than two in three idiot patients was actually doing. Adjusting the doses and courses (you'll usually get three much higher-dose pills these days even though the seven-week is still better) to compensate for human stupid is one of the reason the new antibios have lasted longer than the old ones. Because apparently you people are too stupid to do what your doctor tells you. So... thanks for the resistant staph, morons.

Notabunny:fta the most unnerving graph in the whole report: It shows the sharp drop in applications for new antibacterial drugs over the last three decades.

So the problem is that scientists are either lazy, or they've declared war on sick people.

It's more that variations on Penicillin with minor chemical changes to fool bacterial immune systems by changing the sterics were low-hanging fruit, but eventually you run out of changes that won't also remove the effective bits.

Plus, as mentioned above, new drugs have started to last longer as medicine has started figuring out all the pants-on-head retarded crap patients were doing to cause the problem in the first place, and finding engineering workarounds.

Jim_Callahan:2. The biggest problem isn't overdiagnosis, either, it's partial courses of treatment. If you're given a course of antibiotics by your doctor, you have to take the full doses, on schedule, even after you feel better. Someone that takes a one-week course of antibiotics may potentially release some resistant bacteria, but most likely their immune system will murder any resistants produced once the nonresistant population is wiped out to well below illness-level.

However, if you take three days in a week-long treatment course, feel better, and figure that you can just not take the rest, you a guaranteed to produce resistant species, and extremely likely to spread them to others. This is how resistant strains are produced in laboratory studies (including one used in the review linked above). It takes about four days for someone on a partial dose of an antibiotic to start producing resistants, if you don't shove the population all the way down to where your immune system nixes the remainder (including the resistants), which requires continuing to kill them off even after you're below the bacterial population that makes you feel bad, you are intentionally creating transmissible resistant strains of your disease.

So if you read articles like this and think you can help by taking less of your prescribed medicine, then you're doing the opposite. And if I sound frustrated about this, it's because behavioral studies indicate that my little hypothetical "get prescribed a week of pills, feel better, stop taking them halfway" was what more than two in three idiot patients was actually doing. Adjusting the doses and courses (you'll usually get three much higher-dose pills these days even though the seven-week is still better) to compensate for human stupid is one of the reason the new antibios have lasted longer than the old ones. Because apparently you people are too stupid to do what your doctor tells you. So... thanks for the resistant staph, morons.

That's not the point of the article, the way I read it. It says don't take antibiotics for every damn thing, only for actual bacterial infections. NOT reduce the amount taken for a course, but limit the regularity you take/get a prescription.

I got an FB message that a friend who'd been in the hospital about 6 weeks ago to have an abdominal hernia fixed up was back in the hospital for an MRSA infection operation. So far she's doing better, but she's become in my mind a reason to avoid going to the hospital. As if this was 140 years ago.

Smoking GNU:That's not the point of the article, the way I read it. It says don't take antibiotics for every damn thing, only for actual bacterial infections. NOT reduce the amount taken for a course, but limit the regularity you take/get a prescription.

True, but everything he said is correct. And the reason antibiotics are prescribed for non-bacterial infections is because some people have weak immune systems, and the antibiotic is to prevent a secondary infection. It's true that it's stupid to do this for most people, but some people actually need it.

Abacus9:Smoking GNU: That's not the point of the article, the way I read it. It says don't take antibiotics for every damn thing, only for actual bacterial infections. NOT reduce the amount taken for a course, but limit the regularity you take/get a prescription.

True, but everything he said is correct. And the reason antibiotics are prescribed for non-bacterial infections is because some people have weak immune systems, and the antibiotic is to prevent a secondary infection. It's true that it's stupid to do this for most people, but some people actually need it.

I accept that his point is valid and also that to avoid secondary infections might be needed for people with weak immunity, but the vibe i get lately is that a lot of doctors prescribe antibiotocs to prevent secondary infections for everything, which is what is causing the rise in anti-B resistant drugs, as illustrated in the article. The more people that take anti-Bs for any conceivable reason, the more likely anti-B resistant bacteria arise.

Jim_Callahan:2. The biggest problem isn't overdiagnosis, either, it's partial courses of treatment. If you're given a course of antibiotics by your doctor, you have to take the full doses, on schedule, even after you feel better. Someone that takes a one-week course of antibiotics may potentially release some resistant bacteria, but most likely their immune system will murder any resistants produced once the nonresistant population is wiped out to well below illness-level.

This is tickling my skepticism bone, and I can tell you exactly why. Most (maybe all) of the bacteria that are have developed drug resistance are found latent in many people. Staph, C. difficil, TB, etc. All those are found latent in quite a number of people who aren't sick.

If you are taking an antibiotic to treat (say) a strep infection, it's not just the strep bacteria that's being affected, it's also the staph and C. difficil and E. coli that are present all the time in the body. Assuming the antibiotic doesn't kill them off (and it probably won't, since the drug is not targeted at the parts of the body they infect), they will eventally start to evolve resistance to those drugs even if everyone always completes their treatment.

Unfortunately, I don't think there's anything we can do to prevent eventual drug resistance in latent bacteria. We have to keep developing other drugs and treatments to stay ahead. And maybe phase out some antibiotics for use only in lifesaving situations.

However, if you take three days in a week-long treatment course, feel better, and figure that you can just not take the rest, you a guaranteed to produce resistant species, and extremely likely to spread them to others.

Maybe if a million people do that. The individual risk of creating a resistant strain for skipping four days of treatment is miniscule. But just as someone in the world wins the lottery every week, the resistant gene is finding its way into a bacterium somewhere, and in the world of infectious diseases it only has to happen once.

I remember the only time I was prescribed antibiotics. The doctor told me I should feel better in a couple of days but that it was absolutely essential that I finish the prescription. He told me that, at the tail end of treatment, even if I felt perfectly fine and there were only two or three pills left, I should take them according to his instructions. Otherwise, he said, the infection could come back in a resistant form and I could get pericarditis and die.

Yes. The doctor actually told me that if I didn't follow his prescription exactly, I was risking death. Naturally, I followed his directions. And, luckily I haven't had the need for antibiotics since. And, I'm thankful for that because the pills made my pee smell weird.

Sounds like you may have had strep throat, in which case your doctor was probably worried about rheumatic fever. Contrary to popular belief, this isn't actually caused by the strep bacteria itself but rather your body's own immune response to the bacteria accidentally becoming overactive and attacking your actual organs (i.e, heart and joints) so the role of the antibiotics would be to ensure killing off all the bacteria before your body really gets a chance to mount the immune response (and thus reducing the risk of the immune response becoming overactive).

Your post is actually a good example of how lack of medical knowledge among the general populace is a serious problem and contributor to the issues we have with dosing out antibiotics. Part of it is our society's tendency to think of every problem as a simple black and white issue when the truth is that every antibiotic regimen works very differently and treating different types of infections require very different strategies and lengths of antibiotic use. Sometimes, as in your case, it is absolutely justified to use antibiotics for a full regimen to reduce the risk of any potential complications and sometimes, as hardinparamedic has mentioned with his sepsis examples, it is wise to hold back on antibiotics until you figure out the full situation because using the wrong ones prematurely may just cause MDR and make a bad situation worse. And with all of this confusion, there ends up being more misinformation distributed to the public about how antibiotics work, which ends up causing patients to be less compliant about taking their meds (how many laypeople do you think will read this news article and conclude that it means they should never EVER need to take antibiotics again?). It's a vicious cycle that, IMHO, needs to be fixed by increasing primary care in this country and properly educating people on how medications work.

BTW, no offense intended to you personally, eraser8. I'm just using this as an example of the widespread difficulty of explaining how antibiotics work to people who weren't trained in a medical or pharmaceutical filed. And for all I know, maybe your doctor just did a shiatty job and didn't bother to provide a good explanation to you.)

Doesn''t stop me requesting Keflex after a surgery, because it kills your stink bacteria as a bonus. You still WANT a shower, badly, but you don't have to if your wound needs to keep dry. Keflex is why I can enjoy human company after a slicing session, without their fleeing from the room holding their noses.

Manute Bol says no shiat Sherlock. Stevens-Johnson syndrome is like being boiled alive from the inside and it's a side effect of every antibiotic. Having seen a couple of cases I'm usually willing to forego antibiotics for every sniffle and cough and wait for a definitive indication for them.

the_vegetarian_cannibal:hardinparamedic: Mister Buttons: And, in theory at least, preventing superbugs shouldn't be the kind of thing that Democrats and Republicans disagree over.

I'm willing to bet you have an "antibiotic resistant superbug" living on your skin and in your nostrils at this very moment as part of your normal microbiota.

The only things that really scare me as a provider are EDR Psuedomonas, multi-drug resistant clostridium difficile and MDR/XDR Tuberculosis.

Sounds like somebody needs a FECAL TRANSPLANT!!!

/and for those of you not in the know, yes that is a real actual medical procedure

Did you hear about the new research they're doing with this to fight obesity? A lot of it apparently has to do with what type of bacteria you have in your GI. They took the bacteria from identical twins, one skinny and one obese, and injected it into rats. The rats were given the same type and amount of food. The one with the bacteria from the obese twin became obese, and the one with the bacteria from the skinny twin stayed skinny. I'm not making this up, but I don't have anything to cite (I just heard about it yesterday on the radio). You know how it goes with science reporting, but I thought it was kind of interesting (and sort of on topic).

Alexander Fleming warned of the dangers of antibiotic resistance in his Nobel lecture in 1945.

But I would like to sound one note of warning. Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in underdosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X's death? Why Mr. X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.